Elevated troponin levels after prolonged supraventricular tachycardia in patient with normal coronary angiography

Area of Science:

• Cardiology
• Biomarkers
• Emergency Medicine

Background:

• Myocardial infarction (MI) diagnosis relies on elevated cardiac biomarkers, like troponin, alongside ischemic symptoms or ECG changes.
• Troponin's accuracy in identifying myocardial necrosis is high, but elevations can occur in non-atherosclerotic cardiac diseases.
• Chest pain evaluation in emergency settings frequently utilizes troponin for risk stratification.

Observation:

• A 49-year-old female presented with chest discomfort, nausea, and diaphoresis.
• The patient had a history of supraventricular tachycardia.
• High serum troponin T levels (0.143 ng/ml) were detected during risk stratification.

Findings:

• Despite elevated troponin T, the patient's coronary angiography was normal, ruling out obstructive coronary artery disease.
• The clinical presentation, including supraventricular tachycardia and chest discomfort, suggests an alternative cause for troponin elevation.
• This case challenges the assumption that elevated troponin always signifies acute myocardial infarction due to atherosclerosis.

Implications:

• Clinicians must consider non-atherosclerotic causes of elevated troponin, especially when coronary angiography is normal.
• Further investigation into the mechanisms of troponin elevation in conditions like supraventricular tachycardia is warranted.
• Accurate diagnosis requires integrating biomarker data with clinical context and non-invasive/invasive testing.